Patient centered medical home experience and healthcare services disparities among near-old and older race/ethnic minorities in the US: Findings from the Medical Expenditures Panel Survey

Background: The Affordable Care Act is the most recent federal legislative effort to establish healthcare quality improvement and reduction in care inequities as national priorities. Access to Patient Centered Medical Home (PCMH) care is thought to be a pathway to achieving these goals. Research on PCMH care among racial/ethnic minorities, especially older adults, remains scant.

Design: I use five years of nationally representative pooled cross sectional data (2007-2011) on near-old and older adults (55-years and older) from the Medical Expenditure Panel Survey (MEPS). I focus on three race/ethnic groups measured using respondents’ self-classification as Non-Latino White, African American, and Latino. I use factor analyses to validate respondents’ assessment of four PCMH domains as measured in recently published survey based studies (e.g. Romaire et. al., 2010, 2012; Aysola et. al., 2013): accessible, patient centered, comprehensive and compassionate. First, I provide national estimates of PCMH care among older race/ethnic minorities. Second, using generalized linear models, I test the moderating role of PCMH care in the relationship between race/ethnicity and three healthcare services outcomes: total healthcare expenditures, emergency department use, and rating of care quality.

Results: Less than 1 in 5 respondents reported receiving personal physician directed PCMH care; Latinos (13.5%) reported the lowest level of PCMH experience. Compared to having a usual source of care, PCMH care was associated with lower total healthcare expenditures, lower ED use, and higher rating of care quality. I found mixed support for the moderating role of PCMH care in health services disparities. However, PCMH experience was more likely to improve outcomes among Latinos than African Americans relative to non-Latino Whites.

Conclusion: While there is a clear need for improving the healthcare experiences of all older adults in the US in order to achieve national priorities of increasing overall quality of care, there are distinct disparities that must also be addressed. Policy initiatives aimed at addressing accessibility to personal physician directed healthcare are especially needed. PCMH care can be a valuable national model to enhance healthcare services quality and to calibrate use. Its role in reducing healthcare services disparities requires more research.